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Dr. Gaudet: Postpartum Balance Plan

A few months ago I met with a woman named Maggie. She'd come in for an integrative health plan, but our conversation turned to the birth of her son, Adam, now 4. She loves being a mom, she told me, but she hadn't felt like herself since he was born.

"My body changed," she said. "I can't pinpoint how, but I've never felt the same." Some of it was weight-related -- she'd only lost half of what she gained during her pregnancy -- but it wasn't that simple. "I used to feel so strong and 'in my body.' Now I feel disconnected from it." When I asked how she was doing emotionally, she shrugged. "I'm not depressed. But I don't feel the joy I used to feel. Maybe that comes with being a mom."

Maggie and I uncovered the source of her disconnect. While her pregnancy had been smooth, the labor and delivery were very difficult. Caught up in the sleep-deprived haze of new motherhood, she had tucked the experience away in a corner of her mind. We came to see that she'd never talked about the trauma, let alone healed from it.

There are few events as transforming as having a baby and becoming a mom. Regardless of the kind of birth experience you have (joyous or traumatic, a C-section or vaginal delivery) or the outcome (a "perfect" baby and a body that's feeling great, or a baby with challenges and a body that's hurting), you'll never be the same.

And while new parents readily acknowledge that "everything changes," our culture -- the conventional medical culture especially -- does little to acknowledge or support the significance of the transition. After delivery, you're discharged home in a day or two, perhaps three if you've had a C-section. Your next visit with your ob-gyn is typically six weeks later, for a brief visit and exam. Most often there's no formal support for processing your childbirth experience or preparing you for motherhood. It's no wonder, then, that Maggie and countless other women feel a disconnect. I suspect it even contributes to some cases of postpartum depression and anxiety.

Whether you gave birth two days or 10 years ago, you'll benefit from integrating this intense experience. And if you're expecting, or hope to be, you'll be able to prepare consciously.

Seismic Shifts

When a woman bears a child, a number of intense dynamics come into play. Physically, the changes are dramatic and fast compared with the slow progression of pregnancy. For example, your uterus, which spent nine months expanding, shrinks significantly in a matter of days. In addition, as soon as the placenta is delivered, your levels of estrogen and progesterone (which had increased tenfold during pregnancy) drop dramatically. But as anyone who has borne a child knows, having a baby is not merely a medical event. On the soul level, the experience of bringing new life into the world -- a life that would never have existed without you -- is tremendous.

And then, all of a sudden, you're a mom. Your identity, in the world's eyes and in your own, has changed overnight. In the most mundane sense, a typical day in your new life will never be quite the same as a day in your old life. And your life's path has changed in a profound way -- you'll now move through the world as a mother. This isn't better or worse than not being a mother, but it's very different.

All this happens against a backdrop of another change -- a sudden shift in attention. Whereas for nine months family, friends, and even strangers doted on you, suddenly all the attention is focused on the new baby. Aside from a quick "How are you doing?" there's often little attention on you.

With so much change so quickly, then, it makes sense that many women feel, as one of my patients put it, "strangely discombobulated." Even when a woman's birth experience is positive, or magical, it's often so "otherworldly" that many women compartmentalize it. This is more likely if the experience was traumatic.

No matter when you gave birth, make some time to write in your journal about the experience. (If you're an overwhelmed new mom, this may not be top priority; it's fine to put it off for a few months.) First, document the "outside story," the play-by-play of what happened. Then write about the "inside story." Reflect on how you felt before, during, and after the birth. Was it everything you had imagined or nothing like you thought? Was it empowering and magical or a nightmare? Finally, share your reflections with someone you're close to. It's important that this person play the role of "witness" -- not to fix or interpret things, but rather to honor your story with her complete attention.

Now do the same steps, reflecting on your transition to motherhood. What's the outside story of it, and what's the inside story? What are the greatest joys about it, and what are the greatest fears? Explore the entire spectrum of your feelings, and then share them with a witness.

Baby Blues and Beyond

It's not unusual, of course, for new moms to feel worse than discombobulated. As many as 80 percent of women experience the "baby blues," marked by uncontrollable crying. The baby blues usually peak three to five days after delivery, most often subsiding within 10 days. Though this condition requires no medical treatment, it does call for plenty of self-care, nurturing, and support.

If mood swings persist for more than two weeks, talk to your doctor. Postpartum depression (PPD) isn't a bad case of the baby blues; it's a different disorder altogether, affecting between 10 and 15 percent of women. While it often occurs within four weeks of delivery, it can appear anytime during the first year. Very often, women feel too ashamed to get help. One of my patients, a 24-year-old woman named Jane, suffered in silence for a year because she "felt like a failure and wanted so badly to be a good mom." It's critical to remember that PPD is a real disorder that needs treatment, and is no reflection on you as a person or as a mother.

I've witnessed another, more subtle phenomenon that can affect both new moms and their partners. When you become a parent for the first time, fears or losses left over from your own childhood may return in a sort of "boomerang" effect. My patient Sonia, for example, who had raved about how caring her husband was during her pregnancy, called me about a month after she had a baby. "It's the strangest thing," she said. "Tom's been great in every way. And yet I'm feeling critical of everything he says and does, even the way he looks!" Sonia's own father, it turned out, had abandoned the family when Sonia was six years old. Having her own child activated the leftover loss and anger she'd carried around; she was terrified that Tom was going to leave. None of this was based on rational thought, but it made a lot of sense. My "prescription" for Sonia was to keep exploring her feelings about her dad and then to share them with Tom. As Sonia saw, by bringing old baggage into consciousness, you minimize its impact and begin to heal the old wounds.

Dr. Gaudet's Postpartum Balance Plan

Birth puts your body, your soul, and your life in an incredible state of flux. Striving for balance, however, is critical -- for both your own well-being and your baby's. Here's my best advice for new moms:

1. Be conscious about food.

It's very common (and completely understandable) for new moms to revert to unhealthy eating habits. Keep in mind, though, that how you nourish yourself will either tip you in the direction of balance or imbalance. Having regular, healthy meals and snacks will help keep your energy and mood steady. As exhausted as you are, resist the lure of caffeine and alcohol (both can disrupt sleep), and go easy on sugar. Since you don't have time to shop and bake all day, ask for help. Perhaps a friend can make you a pot of soup, or a neighbor can pick up some vegetables for you. And keep local restaurant menus on hand; healthy takeout is far preferable to Pop-Tarts for dinner.

2. Move a little every day.

Many new moms focus on losing their "baby weight," but I encourage you to be gentle with yourself about this. With all of your routines in flux, it may help to think not in terms of exercise (i.e., an hour dedicated to exertion and sweat) but rather movement -- a 20-minute walk around the neighborhood, stretching for 15 minutes. When you can work in more formal exercise, consider at-home options like aerobics and yoga DVDs or, space and funds permitting, a treadmill or elliptical machine.

3. Stay connected to yourself.

Do a five-minute body scan each week: Sit quietly and close your eyes. Starting at your feet, slowly scan your body, noting any areas of pain or discomfort. Pay special attention to your pelvic area and breasts. Spend another few minutes each week journaling about how you're feeling. Tired beyond belief? Joyful? Grateful? Sad? At your wit's end?

4. Get support.

Having a baby can be very isolating. If you don't have a support network, seek one out -- ask your ob-gyn about "new mommy" groups in the area. Make conscious choices about the kind of support you need and want, as well as the kind you don't. If your sister is passive-aggressive and critical, don't say "sure!" every time she wants to swing by to see the baby. And above all, break through any feelings of not wanting to be a burden, and ask for what you need.